Effect of intraoperative dexmedetomidine on renal function after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a randomized, placebo-controlled trial

Abstract

Introduction: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) predispose to postoperative renal dysfunction. Dexmedetomidine is an a 2 adrenoreceptor agonist, which has renoprotective effects after cardiac surgery. Objective: To assess the effect of dexmedetomidine on renal function after CRS and HIPEC. Materials: Thirty-eight patients undergoing CRS and HIPEC were randomized to receive dexmedetomidine (dexmedetomidine group, n ¼ 19, loading 1 lg/kg over 20 min followed by infusion at 0.5 lg/kg/ h) or 0.9% sodium chloride (control group, n ¼ 19) during surgery. Creatinine clearance (CrCl) was assessed daily until postoperative day 7. Urine neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule (KIM)-1 were measured for 24 h after surgery. Results: There was no difference in the lowest CrCl value during the first 7 days postoperatively, but the % change from baseline to the lowest value was lower in the dexmedetomidine group than in the control group (p ¼ .037). Urine NGAL and KIM-1 levels were increased over time in both groups, but the increases were significantly less in the dexmedetomidine group (p ¼ .018 and 0.038, respectively). In the dexmedetomidine group, the length of intensive care unit stay was shorter (p ¼ .034). Conclusions: Intraoperative dexmedetomidine infusion did not improve renal function in terms of serum Cr-related indices following CRS and HIPEC. However, as the decrease in CrCl was attenuated and early tubular-injury markers were lower in the dexmedetomidine group, dexmedetomidine may have protective effects against early tubular injury in CRS and HIPEC.

The effect of dexmedetomidine on renal function after surgery: A systematic review and meta‐analysis

“…A total of 19 studies with 3,395 patients were included in the final pooled analyses. [3][4][5][6][7][8][11][12][13][14][15][16][17][18][19][20][21][22][23] Of these patients, 1,683 received dexmedetomidine while 1,652 did not. Study review and inclusion is outlined in Figure 1.…”

Dexmedetomidine Alleviates Lipopolysaccharide-Induced Acute Kidney Injury by Inhibiting p75NTR-Mediated Oxidative Stress and Apoptosis

“…Intraperitoneal injection of DEX was able to alleviate oxidative stress damage in LPS-induced acute liver injury [14]. Of particular importance is the protective effect of DEX on perioperative AKI revealed in several clinical studies [9,15]. Experimental studies have demonstrated that DEX remarkably attenuates renal oxidative stress and apoptosis in early LPS-induced AKI [16].…”

The Benefit of Dexmedetomidine on kidney are associated with the inhibition of oxidative stress during hyperthermic intraperitoneal chemotherapy: a randomized trail

“…In our center, most patients with GI cancer were treated with cisplatin as chemotherapy during HIPEC, including present study, which may be one reason for increased serum Cys-C level. Nevertheless, other factors such as renal hypoperfusion and ischemia caused by intra-abdominal hypertension and heat stress response may play critical roles in the development of AKI [9,20] . We inferred that the elevated serum Cys-C, Cr, BUN and UA may related to HIPECinduced oxidative stress, so the alterations of serum MDA and SOD levels were detected, which are good indicators of the oxidative stress.…”

“…Dex is a sedative and analgesic drugs widely used in perioperative period, which is a highly selective a2 adrenoreceptor agonist [8] . Previous studies have demonstrated that Dex could protect against tissues injury by preventing oxidative stress [9] . Therefore, we speculated that administration of dexmetomidine during HIPEC may in uence redox state in vivo, and further affect the function of renal and liver as well as patient prognosis.…”